The delicate balance between pro-(risk of thrombosis) and anti-(risk of bleeding) coagulation during extracorporeal membrane oxygenation

During veno-venous extracorporeal membrane oxygenation (VV-ECMO), a pump drains blood from a large vein, moves it towards a membrane oxygenator, where gas exchange occurs, and then pushes it back into a large vein (1). Blood is thus continuously exposed to non-biological surfaces, including cannulas and membrane oxygenator, and high shear stress, mainly generated by the pump. Platelets and coagulation are activated so that systemic anticoagulation is needed to prevent thrombosis, inside and outside the body.